| NPI | 1053702803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704311557) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704311557) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: SC 226425) | |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2024-04-25 |